The (1st Middlesex) County Asylum at Hanwell, also known as Hanwell Insane Asylum, and Hanwell Pauper and Lunatic Asylum, was built for the pauper insane. Hanwell was the first purpose-built asylum in England and Wales, and it opened in 1831. Some of the original buildings are now part of the headquarters for the West London Mental Health (NHS) Trust (WLMHT).

Its first superintendent, Dr William Charles Ellis, was known in his lifetime for his pioneering work and his adherence to his "great principle of therapeutic employment". Sceptical contemporaries were amazed that such therapy speeded recovery at Hanwell.[1] This greatly pleased the visiting Justices of the Peace as it reduced the long term cost of keeping each patient. Under the third superintendent John Conolly the institution became famous as the first large asylum to dispense with all mechanical restraints.[2][3]

The asylum is next to the village of Hanwell but parochially belongs[clarification needed] to the suburb of Southall (and before a boundary change it was in Norwood).[4] It is about 8 miles or 13 km west of Central London and 6 miles (10 km) south-east of Uxbridge. (O/S map ed 1896)

Today the on-site facilities have been reduced from what was once the world's largest asylum, although it is still used for treatment of and research into serious mental distress. A prior trust created the London West Mental Health R&D Consortium[6] which also has its administrative base there. There is now a complex of other buildings known as Ealing Hospital NHS Trust built on the old asylum's recreational grounds and cycle track to the east. At the back of the main building are some disused wards that still belong to the Regional Health Authority.

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But there is something at Hanwell more precious than any of these. As a traveller by the Great Western Railway dashes through it, his attention is arrested for a moment by a large building on the southern side of the railway, a plain but handsome structure, which stands cheerfully in an open country, and discloses even to the hasty glimpse of the traveller, as he hurries past, evident indications of careful and attentive management. It is the LUNATIC ASYLUM for the county of Middlesex, one of the most interesting buildings in the kingdom ; a temple sacred to benevolence, a monument and memorial of the philanthropy of our times.

Several Acts of Parliament allowed the building of the Asylum, and statutes have driven the subsequent changes in mental health care. The background to the creation of the asylum included the 1808 County Asylums Act which was passed after an expensive war against France. This recognised lunatics as being ill, as being held in the wrong institutions and perhaps having a chance to recover if given the right type of treatment. Non-recovery would mean that the insane pauper would always need to be looked after, which would cost more in the long run. Some parishes were growing in population due to industrialisation, and the existing charitable institutions and workhouses could not cope with the increasing demand. The recognition of insanity as an illness can almost be seen as a cost-saving measure rather than a humane one.

"Whereas the practice of confining such lunatics and other insane persons as are chargeable to their respective parishes in Gaols, Houses of Correction, Poor Houses and Houses of Industry, is highly dangerous and inconvenient" [7]

The 1808 Act was passed to empower county Justices of the Peace (JPs) to construct asylums financed out of the local rates, which proved very unpopular. As JPs faced annual re-election, they often met resistance to this policy. The cost of keeping lunatics in jails and workhouses had previously been charged to their parish of birth, and continued indefinitely as there was no attempt to cure them.[8] To make matters worse, the Corn Laws kept food prices high while the Enclosure Act of 1813 removed the right of poor people to use the common lands to support themselves, causing added mental distress to the already impoverished.

Concern grew about the disproportionate number of lunatics in Middlesex. The local judiciary (before whom the lunatics would have appeared charged with various offences or running amok) decided on 15 November 1827 to exercise their powers and build an asylum.[9] In the following year Parliament recognised the barriers to asylum building (mostly financial) and passed the 1828 Metropolitan Commissioners in Lunacy Act to ensure the 1808 Acts was enforced. It gave JPs the powers to progress things more rapidly.[citation needed]

Work on the new asylum at Hanwell started in 1829. Most of the land – 44 acres (180,000 m2) – was purchased from the Earl of Jersey. The building contractor was William Cubitt, who completed the work to a tight budget of £64,000.[10]wc[›] The architect was William Alderson. His neo-classical design consisted of a central octagonal 'panopticon' tower with a basement and two other floors. The windows are tall with semicircular bonded gauge brick arches at the top. There were two wings of one basement and just one other floor in the form of a west-east corridor.[11] Both wings turn north, and each terminates at its own panopticon tower, which again has a basement and two floors; the overall building forms three sides of a square. The east side of the central tower was intended for the male patients and the west for the females. With germ theory beginning to be developed around this time, spreading the wards out in this manner was thought to help reduce the spread of infections.

The design also reduced the need to build corridors and saved money. The wards themselves were long and thin with a corridor from one part of the asylum to another running through the ward itself. From the air the design is roughly symmetrical with services: kitchens; laundry; management; chapel and hall (used for parties, theatre and dances) all located in the middle with wards laid out to each side, male to the left of the entrance and female to the right.

As Hanwell was the first purpose-built asylum in England and Wales, this became one of the two standard design plans for county asylums[citation needed] and was copied and modified by the designers of countless other asylums across England and Wales (for example Horton, Colney Hatch (Friern), Claybury, or Springfield). The main alternative design being the villa plan (for example Chalfont or Shenley). The one item that Hanwell did not possess was a gymnasium; in later designs this was often built under a first floor hall. Hanwell's hall is said to have had a ward beneath although this area has been offices for many years.

The central tower was adorned with a monumental clock procured from John Moore & Sons of 38–9 Clerkenwell Close, London. This was later moved to the Chapel tower[12] when the chapel was built. In November 1829 building work started again on the first extension, and there were further expansions in 1837, 1857 and 1879. The extensions which were added in 1857–59 are readily identifiable, as they have flat bonded arches to the tops of the windows.

The building was designed as a functional work space and home for the treatment of insane paupers, rather than a residence or civic building. This unfortunately led to poor ventilation, and together with overcrowding may be the reason behind the high rates of tuberculosis before the age of antibiotics.[citation needed] This was made worse when the basements were converted into sleeping dormitories and even a few extra wards, by excavating earth away from the basement walls and fitting windows. This worked quite well for much of the east side where the ground level is almost 5 metres lower than on the west due to the slope.

The main view most people see of the hospital is the elegantly proportioned gatehouse entrance which adjoins the Uxbridge Road. It takes the form of a neoclassical half-circular arch, large and solid, over tall vertical barred, iron gates, which incorporate a small pedestrian gate with its own key lock. The harsh architecturally solid lines are softened somewhat by the vine creepers that envelop the upper parts. Surprisingly, it is built from pale grey Gault bricks which are not only gauged but had to be expensively brought in.

On the north side of the building there is a blue Ordnance Survey Bench Mark. This point was measured to be 69.279 feet (21.116 m) above mean sea level.[13]

The asylum opened on 16 May 1831 under the administration of the local Committee of Visiting Justices of Middlesex County Council. Upon opening it admitted twenty-four male patients and eighteen female patients.[citation needed]

The first superintendent was Dr William Charles Ellis. His wife, Mildred Ellis, held the post of matron, from the opening in 1831 until William Ellis' resignation in 1838.[1]

It was found essential for recovery that the patients should get out into full daylight for fresh air and exercise, so the ground floor wards had 'airing courts' which were shared by the other wards upstairs. These were pleasantly laid out areas with seating and bounded by walls or railings. Some patients, well into their recovery, were allowed to walk and work in the surrounding fields. The asylum had its own carpentry, bakery and brewery along with many other services and was as self-sufficient as possible. The asylum paid the canal company for taking water from the canal and had its own dock to receive barges. This was very convenient for receiving coal deliveries, which was used not only for heating but for producing gas for lighting.

Hanwell Asylum, The Chapel – c.1875

Originally planned to house 450 patients, with space for a further 150, its capacity was reduced back to 300, with space for another 150. This was due to fears of an outcry if the local tax rate increased too sharply. At first the number of paupers admitted was low due to the charge of nine shilling per week each, this being higher than the workhouses and jails, but by force of the law the asylum was full within six months and more space was badly needed. In November of the same year, work on building extensions began to address this problem, and so started the almost continuous process of rebuilding and improvements that go on in the present day.[14]

The friends or relatives of a deceased patient were free to remove the remains for burial. Failing this, the deceased were interred in unmarked paupers' graves in the hospitals burial ground. With the 1832 Anatomy Act, the body was first kept in a building called the 'dead house', on the west side of the burial ground (see diagram above). If unclaimed after 72 hours it could be sold to a licensed anatomy school. The Act also provided for the donation of bodies.

As autopsies on paupers did need require the coroner's permission, autopsies became common at the hospital. From 1845 the results of these autopsies were recorded in detail by Dr Hitchman.[15]

John Conolly took up residence as the third superintendent on 1 June 1839. In April 1839, Serjeant-at-law John Adams, one of the Visiting Justices of the asylum and a founding member and first chairman of Legal & General, suggested that Conolly visit the Lincoln Asylum and see the system operated by Robert Gardiner Hill.[16] He was so impressed by this that he decided to abolish mechanical restraints at Hanwell. This must have taken enormous powers of persuasion: the existing staff would have to change their work practices and learn how to nurse more effectively those patients with troubling behaviour. However, the reform seemed to avoid the patient suffering further trauma as a result of restraint and being made to feel completely helpless. Conolly succeeded in introducing the reform by 21 September 1839, less than 3 months after he took charge. This is perhaps a testament to the earlier work of Ellis.[17]

Something of Connolly's success can be gauged from this extract from the first page of the 68th report of the Visiting Justices:

The Visiting Justices have the satisfaction to find that every year, as the excellence of the non - restraint System becomes more generally recognized, affords fewer Materials in the Asylum for Comment or Report. For four years it has been the settled Rule of the House, that no harshness nor coercive cruelly should be used in any case, but that every patient, however violent, should be treated with uniform kindness and forbearance; and during that time such as been the undeviating success of this Plan, such as been the even tenor of it course, that it now presents no new fact nor features either to vindicate or explain. This is the more extraordinary, as it rarely happens that a Theory can be brought into practice without losing a Portion of its presumed Efficiency.

—Charles Augustus Tulk, The Sixty-eight Report of the Visiting Justicies appointed to superintend the management of The County Lunatic Asylum at Hanwell, 26 October 1843

In 1888, the earlier 1879 Act of Parliament to facilitate the control and care of Habitual Drunkards was made permanent (and the term 'Habitual Drunkard' changed to 'Inebriate'). As Hanwell would take in such patients for up to a year, this Act was seen as a reason to close the brewery m[›]. However the patients pub (or bar) "The Bees Knees" continued to sell alcoholic beverages until the mid-1990s.

With the term "London County" being introduced for the greater London area, the asylum was renamed the London County Asylum in 1889.

On 11 June 1910, nurse Hilda Elizabeth Wolsey followed a female patient who climbed one of the fire escapes and then along the guttering of the ward roof. She held on to the patient until help arrived and they could both be lowered to the safety of the ground. For this act of heroism she was awarded the Albert Medal which was exchanged for a more suitable George Cross in 1971.[19]

Taken in the first half of the 1920s this image shows that the nurses' home has still to be built in the top right corner of the frame. It has since been demolished. Further to the top right is the railway Iron Bridge[disambiguation needed] at the junction of Uxbridge Road (A4020) and Windmill Lane (A4127) which runs south to the left of the frame. Running down the left-hand side is a section of the 'Flight of Locks' on the Grand Union Canal.

By the 1920s there were sufficient beds to ensure that no person too ill to keep within the laws of the land (or avoid getting misled by others into transgressing the law) need be sent to gaol. Local prison population subsequently fell.[20]

One ward of the hospital was used as the local 'Emergency Medical Services (EMS) centre, to treat war casualties during the Second World War.[21]

Several bombs landed on the hospital and its grounds during the war. It was close to two strategic targets: the AEC factory in Windmill Lane which built fighting vehicles, and the Wharncliffe Viaduct which carried the Great Western Railway, a vital transport route. Some of the UXBs fell into the soft sediment of the River Brent, and some may still be there. However a V1 hit the hospital laundry and caused many casualties. This event is mentioned in a personal account by Simon Tobitt in WW2 Peoples War.[22] The Gatehouse also received some bomb damage.

Following the second world war, new medicines were found to be effective in the treatment of many of the major mental illnesses, see Chlorpromazine. Following refinement and clinic trials they were introduced at the end of the 1950s and made a massive positive impact on the hospital. At last there was an effective treatment, and as a result the containment aspect of segregated patients within wards could for most wards be relaxed. As their illnesses responded to treatment patients recovered and started to be discharged. In the early 1960s the hospital reached its maximum size (around 3.800 patients in over 100 wards) but now started for the first time to discharge more patients than it admitted. Later the main and secondary gates were unlocked during the day removing forced segregation from the outside world and in 1975 the eastern wall was removed to make way for a new general hospital to be built in the asylum grounds.

At an unknown time in the 1960 or '70s the ward numbering scheme was replaced, the earlier system was a letter defining the sex followed by a number: F23 - the 23rd Female ward for instance or M4 a male ward. The new system consisted of giving each block a letter of the alphabet and then attaching a number to it: D2 or E1, each block containing between one and eight wards depending on location. It is presumed that the naming system attempted to reduce the perceived size of the hospital to visitors and new patients, being admitted to say the 23rd female ward gave the impression of an awful lot of female patients, compared to being admitted to say K2 ward. Later (perhaps in the 1970s) these designations allowed for names to be used using that first letter 'D2' the middle floor ward of 'D' block, the fourth block from the left became 'Dean Ward' with ; whilst 'E1' became 'Elgar' with 'E2' 'Eliot', and 'E3' 'Emerson' on the top floor.

Away from the main 'asylum' buildings, on spare ground on the west side of the hospital seven bungalow wards and other therapy buildings built for World War IShell shock victims (and visible in the photo above as a row of angled new bright roofed buildings). These were given the block designation "O", but despite being the newest buildings, within 20 years most of these wards had been demolished. In the 1980s the remaining buildings had external walls and roofs made from corrugated material, iron or perhaps asbestos with rudimentary wooden interiors.[23] Perhaps they were designed to be quickly erected and used for a short time.

During the 1930s the Adelaide (2 wards: 'P1' & 'P2') and Ellis (4 wards: 'S1'−'S4') groups were built. In the photograph above, the top left corner may show foundations for the Ellis ward group. It is believed that these wards also found work caring for the shell shock victims of World War II. The wards each featured a large covered patio area facing south and looking onto lawns and shrubbery beds allowing patients to sit and relax whatever the weather, sun or rain.

During the 1940s a further set of six bungalow wards were also built to care for more Shell Shock victims, they were built in a similar diagonal pattern to the earlier bungalow wards but further west and were given the designations 'R' 1−6.

After the creation of the NHS all of these newer wards, Adelaide, Ellis and the 'R' bungalow wards being away from the main 'asylum' buildings formed a suite of wards that looked after new mentally ill patients with the aim of assessment; treatment and discharge home or if too ill transfer into the older asylum wards were longer term care was given.

Adelaide now divided into one male and one female ward but with a shared garden and activity rooms and taking admissions from the Ashford and Stains area of West London;

Ellis now divided into three wards Ellis and Brent serving the area of the London borough of Ealing; and Campion serving the area of Southall. In addition an Occupational Therapy OT centre was provided (named Devon).

Bungalow wards R1−6 named after rivers such as Clyde and Avon and taking admissions from Acton, Shepherds Bush, Buckinghamshire and Berkshire.

In the remains of the former 'O' block buildings there were also facilities for Art Therapy, Music Therapy and, until a patient with a complaint against religion burnt it down, a small chapel.

Dr. Max Meier Glatt, (born 26 January 1912; died 14 May 2002)[24] was one of the pioneers in the treatment of people with an addictivepersonality trait. Appointed as a consultant in 1958 he set up an alcohol dependency unit in a female ward. His approach of creating a "therapeutic community" with a 12-week inpatient stay to help patents come to terms with their problems and explore new methods of living in the future without their addiction was found to be a great success. In 1982 this was moved and became a drug and alcohol dependence unit in 'B' block (B7 Blenheim & B8 Buckingham) and although the 12-week inpatient stay was reduced to 10 then 8, and then 6 weeks; this moved again in 2000 and is now known as the Max Glatt Unit and situated in 'A' Block. It is currently run by the Central North West London Mental Health NHS Trust; Substance Misuses Service.[25]

When the unit was originally located in the top floor of 'F' block patients often used to complain that they could smell beer and think that they were going mad. Little did they know that "The Bees Knees" pub was in located nearby in the basement below 'G' block - They really could smell the beer.

Between 1975-1984 the hospital pioneered a massive rehabilitation programme assisting patients whose mental illness was being well controlled to regain life skills lost through many years of being looked after in a large institution − Institutionalisation.

Whilst almost all of the long stay patients had been able to leave the grounds of the hospital for some years few actually saw the need to do so, this seemed wrong as with the control of symptoms offered by modern medicine few now actually care in a hospital setting.

The plan was simple teach each patient how to cope with life outside and slowly reintegrate them back into society placing small groups of friends (2 to 6) together in houses in their former home area. Practical skills such as cooking, clothes washing, and shopping had to be learnt or re-learnt and life skills such as relationships and resolving conflict within the group taught. Some required skills in crossing roads or using buses, others had health problems that they needed to learn to manage. Small trial group homes were created within the hospital to allow each group of friends to learn to manage and nurses assisted patients to go shopping for food or clothes or to the cinema building confidence and skills.

Half-way houses were also created − independent living but still just inside the hospital, two in the Gatehouse on the Uxbridge Road. Patients moved through several stages of living together from large groups with 24-hour staff to forming their own small group and living alone but with a staff member popping in twice a day before moving out completely to live in a house together. Many staff moved from being hospital based to community based and spent their days visiting and supporting groups of patients with their problems.

Some patients formed relationships and wanted to live together as a couple sharing a bed and bedroom; several former patient groups had no local community that they considered home but instead expressed a wish to live in the countryside or by the sea; all were accommodated with the knowledge and support of local social and nursing teams.

Between 1975-1987 nearly 1,700 long-stay patients were discharged from the hospital, some frail and elderly to nursing homes, but most living in their community.

In the mid-1970s a UK Government, (Health Department) trial was announced to try to reduce the stigma of psychiatric hospitals, at Hanwell the a new district general hospital was built in the grounds of the former asylum, The whole site then being named Ealing Hospital and comprising two wings: the General Wing and for the psychiatric hospital "Ealing Hospital, St. Bernard's Wing". The 'wing' being larger both in physical size and inpatient beds than the main hospital. In fact St. Bernard's with over 3,000 beds was more than 6 times the size then the 470-bed General Hospital. Meanwhile in Worcester a new psychiatric unit was built at Newtown Road next to Worcester's Main hospital at Ronkswood, Worcester and replacing the acute and elderly wards of the area's former Asylum, Powick Hospital.

The management of both hospitals remained totally independent with each medical unit reporting directly to the Ealing District Health Authority and not to any board called Ealing Hospital.

However one physical site allowed cost savings with some of the facilities shared; St. Bernard's oil burning boilers for instance were enlarged in number from 4 to 6 to provide hot water and radiator heating to both hospitals, and the existing laundry facilities on the St. Bernard's site, near the boilers, provided bed linen and towels to both hospitals. But the new Ealing hospital building included a larger mortuary allowing the outdated St. Bernard's mortuary to close. Both hospitals retained separate Kitchens, Maintenance, Pharmacy, Telephone exchange and portering services, whilst separate management require separate Finance, Human Resources, and later IT departments.

However, the new nomenclature given to describe the general hospital built in the grounds of the former asylum was found to go against all natural intuition and so forced people to keep resorting to the name "St. Bernard's Hospital" or just "St. Bernard's" to make it clear that they were referring to the psychiatric parts rather than the general hospital which was called "Ealing Hospital" or "Ealing General" by the public. Even by 2006 the old name is often used in internal communications and in-house publications and some National Service web sites still give the address as St. Bernard's Hospital. This approach has proven an effective Coping mechanism against the Petronius syndrome. Likewise, its geographical attachment depends on context. For postal communications it is in Southall, in the county of Middlesex for non clinical administration it is referred to as the 'Ealing site' and to the people to whom it serves it remains in Hanwell, West London W7.

Run by the Forensic Directorate, this unit was named after Isambard Kingdom Brunel's Three Bridges that lies only a few hundred feet away to the west. One of the wards has been named after the rastafariandub poet and mental health campaigner Benjamin Zephaniah. The Three Bridges RSU was originally built on the asylum burial ground, a rectangular area that was walled in by high walls on all four sides except for a gate a mortuary (labelled "dead house" in the 1850 floor plan, above) at the west end. A build within these four walls made a good case for the units location, but a subsequent extension removed much of these walls.

In 1987 the existing Ward 1 of Ealing Hospital, built as an infectious disease isolation unit was reopened as the first NHS hospice in the country, all earlier hospices being charities. With this came an important role for its NHS consultant Doctors to lead the treatment of palliative care in the UK. Ward 1 was renamed Meadow House Hospice.

In 1993 the hospice was a part of the general nursing (non psychiatric) community services that formed roughly half of West London Healthcare (NHS) Trust (see below). However in 1999 service management was again re-formed and this hospice together with other non-psychiatric services parted company.

In 1988, the local District Health Authority, following Government edict to close the smaller cottage hospitals and maternity units, and bring health services together on one multi-disciplinary site, opened a new Maternity Unit in a car park next to The Ealing Hospital, this had the striking feature of a bright blue roof.

In 1992 the Ealing District General Hospital gained "Trust" status, a UK government term that gave the management greater financial powers and was renamed Ealing HospitalNHS Trust. St. Bernard's had to create a new different identity for itself and regained the name of St. Bernard's Hospital once more. Payments for services provided by each separate entity such as hot water and heating now became financial contracts between the two organisations.

Changes to psychiatric healthcare between 1982 and 1990 and in particular new medications, saw the reduction of patients being cared for in 'Long Stay' wards and instead moving from institutionalisation to assisted self-care. Hundreds of patients were supported as they gained or often regained knowledge of how to care for themselves before leaving the hospital to move perhaps into a house with three or four other patient friends initially within, and later discharged to a house outside the hospital. Many of St. Bernard's medical, nursing and para-medical staff moved from hospital based work to community support as a result and towards the end the hospital was able close wards quite dramatically

Changes to UK health service structure and the creation of "Trust" hospitals also caused many changes to St. Bernard's. As a large asylum the hospital treated patients from all over the West side of London and out into the counties of Buckinghamshire, Berkshire, and Surrey in addition to its original intended catchment of Middlesex, and between 1990 and 1995 many of these patients had their care transferred back 'home' to newly build local facilities and St. Bernard's lost catchments such as Shepherd's Bush and Ashford (Staines) The hospital reduced in size as a result.

Date

In-patient Beds

Early 1960s

~ 3,800

Jan 1984

~ 2,100

March 1984

~ 1,800

April 1985

~ 1,100

Dec 1992

~ 380

As the hospital was almost always full from the 1940s onwards, the number of beds is an accurate way of defining the number of patients, and in 40 years the hospital shrank by 90%, however the staff in the 1990s had expertise in secure services and the hospital gained a regionally funded (North West London[26] region) secure Forensic medicine service that was the catalyst for a move into providing the regional and national specialist psychiatric services that are offered today.

The John Conolly Wing was built on the Asylum playing fields, removing the opportunities for patients and staff to play football or cricket. A two story building, it was designed as two East and West halves under another blue roof, a colour matching exactly that of the Maternity unit. A hanging corridor was built from the first floor into the general hospital entrance, but with the general hospital gaining trust status and general hospital patients (and some staff) not keen on having psychiatric patients in the shop areas of the general hospital, this corridor was closed off and is now only used for fire evacuation reasons which admittedly was always its primary design purpose.

To empty the west-side bungalow wards allowing almost half the former asylum site to be sold and converted into a housing estate which would in turn pay for the building of this wing and pay for additional unspecified health building projects in North West London. Four million UK pounds was a figure being mentioned at the time for the sale but this must be considered as unsubstantiated gossip rather than fact.

On opening three wards and their Occupational Therapy centre transferred across from the west side bungalow wards to the west side of The John Conolly Wing together with one ward from within the main asylum building. In line with the then current thinking the new wards had far fewer beds, each new ward had 15 beds in single rooms, replacing wards that all had in excess of 22 beds each in mostly shared single sex dormitories of 2, 4, 6 and 8 beds. Progress in a way, but some psychiatric illnesses cause a withdrawal from the company of others and it could be argued that single rooms do not help.

Three elderly assessment wards also opened on the east side of The John Conolly Wing and as they were created from several different wards, were given new identity names from the Lake District of England:

The growth of high quality regional forensic services and the freedom of 'Trust' status allowed for an expansion of services and a specialisation into purely psychiatric care. In 1998 it was agreed that the existing psychiatric services in Hammersmith, Chiswick, Twickenham, Ashford and Fulham be combined into a new Trust organisation with its headquarters at Hanwell whilst the general non-psychiatric community services and services for people with Learning difficulties / disabilities also became part of new 'Trust' organisations.

A new management strategy was created in October 2000 with the name West London Mental Health NHS Trust as the new organisation with an assortment of new and refurnished buildings and built on a foundation of quality of care, gained contracts to provide psychiatric services to most of West London.

In 2001 and Tony Hillis Wing was opened, named after Tony Hillis who was formerly the Deputy Director of Nursing at St. Bernard's and remembered for being a great supporter of patient involvement and being non-judgemental towards those he cared for.

In 2007, the Orchard Centre was opened, as a medium secure psychiatric unit for women. The Department of Health had conducted a consultation and found that women experiencing mental health problems were poorly catered for.[28] This led to new guidelines being drawn up and published.[29] Part of this guidance called for women who suffer mental problems, and for whom only medium secure accommodation was needed, to be treated in way that was sympathetic with their gender. The WLMHT found itself in an almost unique position in both location, facilities and experience, together with a close working relationship with the London West Mental Health R&D Consortium. All this enabled it to construct a successful business case for a medium secure women-only unit to be built on the St Bernard's site.To meet this end, the design details and layout of the unit has been thoroughly researched to provided those features which are hoped will aid recovery to sustainable health. This work was undertaken by Tuke Manton Architects LLP of Clapham.[30] This was undertaken in partnership with Kier Group PLC, who were chosen by the West London Mental Health Trust to be the building contractors.[31]

The development of the new site as a whole required some of the existing Grade II structure of the hospital to be demolished. This was allowed on the account that these parts were not of significant architectural or historical interest to justify preserving. However, the south boundary wall (a registered ancient monument) had to undergo some renovation work to make it sound again. The old artesian well was considered an important Victorianartifact and was left intact. This required the foundations of the new unit to be built a little further to the south than originally intended.

The current hospital has decided that the asylum buildings can no longer be refurbished in such a way as to support a modern hospital. Plans are to sell of the remainder of the asylum buildings so that they can join the rest as refurbished private housing. The extensive modern buildings at the back (canal-side) of the hospital will remain in use and will be supplemented by further new buildings away from the historical asylum.

The hospital buildings have been used on many occasions as a film or television location due to the proximity to several TV and film studios, Victorian prison-like architecture, lots of external nooks and crannies and during the 1980s and 1990s plenty of empty ward space. Closed down wards became film locations as nightclubs (J block), hairdressers (H block) and free-French army barracks (an F block dining room).

The ITV 1970s TV series The Professionals filmed both outside and inside for several different episodes, most notably in one episode when a car is driven at speed towards the asylum main entrance followed by both main characters running down the white spiral staircase of the central tower into the basement below. At least one other episode uses a ward as a location where the three main characters visit a person supposedly in a general hospital ward.

The BBC 1970s TV series Porridge starring Ronnie Barker used the outside courtyard of the buildings near the old pharmacy (later porters lodge) for outside shots of the prison in several episodes, the pharmacy windows had vertical bars on them, resembling a prison.

Some scenes of the 1989 Batman film starring (amongst others) Jack Nicholson as the Joker, were also filmed in empty wards at Hanwell (using K block). This went down especially well with the staff as an earlier film of Jack's One Flew Over the Cuckoo's Nest (1975), set in an American psychiatric hospital, was at that time a favourite.

Some scenes of Stephen Poliakoff's film She's Been Away (1989) were filmed at the hospital. Dame Peggy Ashcroft starred as Lillian Huckle, a woman who was institutionalized 60 years before whilst still a young girl, simply because she did not conform to social norms.

It is also referenced in Lord Dunsany's story, "The Coronation of Mr. Thomas Shap." and in 'The Big Four' by Agatha Christie: Chapter two, 'The Man from the Asylum'.

Hanwell is also mentioned in H.P Lovecraft's 1924 short story 'The Rats in the Walls', in which an American-born scion of a cursed English house is interred there after discovering the horrible truth of his family's past.

Reverend H A Norris, (a former chaplain to the hospital) realized in the early 1980s that there were old records at hospital which were historically important and should join the others in the Greater London Council Records Library (now part of the National Archives). He feared these would be thrown out by staff, and volunteers formed the 'Museum Committee' to help. They recovered much of the hospital heritage. This also included mechanical restraints, ECT machines, and some of the old fixtures and fittings. The largest item by far was the last original 'seclusion room' with white stained leather-covered straw padding walls and floor, this was recovered from June Ward in J block.

One of the books retrieved in the search by the museum committee was a discharge book, the first entry was within a few months of the asylum's opening and recorded the death of a young woman, it listed her reason for admission as being "Continually sneezing".

Also on display was a letter written by Arthur O'Connor. He had been committed to Hanwell on 6 May 1875 for firing an unloaded pistol at Queen Victoria earlier on 29 February.[34] The purpose of writing was to petition for his release; which was granted on 16 November 1876. He never came to the attention of the authorities again.

^wc: He was no relation to the other famous builder Sir William Cubitt, who lived in the same era. On a housing estate which was built during the mid-1990s on part of the original hospital grounds, the name 'Cubitt Square' was given to one of the residential areas.^m: Although the sedatives Paraldehyde (invented 1829 by Wildenbusch) and chloral hydrate (in 1832 by Justus von Liebig) were known about, they were not used (except for perhaps recreational purposes) in medicine. It was not until about the 1800s when people like Emil Kraepelin studied them, that their medical usefulness was considered. [3] Of course, these were too dangerous to replace the traditional sedative whilst patients consumed alcohol daily. So this may have been the window for the adoption of synthetic concoctions and potions as palliatives.

^br: The bricks are thought to be Smeed Dean Belgrave Yellow Stocks from Kent.[35] The low iron and higher lime content of the mud there gives the characteristic yellow hue to the bricks.

^c: The commuting of staff is a relativity recent phenomenon in the history of St. Bernard's. Before, they would have been able to live in good, clean, and habitable accommodation situated on site. Also, the normal working day back then was twelve hours long with little in the way of street lighting, so the proximity of these facilities was of great benefit. This was provided as a free and a much valued perk with which to attract people of the right calibre.